Lynne A. Valenti
Cabinet Secretary

CHILD CARE ASSISTANCE APPLICATION
FOSTER CARE

Application Instructions

Read the application carefully and answer each question completely. If you have any questions about completing this application, you can call (605) 773-4766, toll-free 1-800-227-3020, or email CCS@state.sd.us.


If your provider is not registered or licensed, they must be pre-approved by Child Protection Services before we can issue any payments to that provider. Contact your child’s social worker prior to making arrangements for non-regulated care.


If you need to locate a registered or licensed child care provider, click here.


Child care providers will bill directly to Child Care Services for reimbursement. If your provider charges more than Child Care can pay, please contact your Child Protection Social Worker for additional options.



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CHILD INFORMATION

Complete for each foster child in your care.


Foster Child
Name (Last, First, Initial)
Race (optional)
Check all that apply
Hispanic
or Latino?
Sex Date of
Birth
Social Security
Number (optional)
Date Child
Placed in Care




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Enter another child
EDUCATION or TRAINING

You must include an offical school schedule for each adult family member attending school


Student's Name Place of
Education or
Training
Credit
Hours
Starting
Date
Ending
Date
Contact Person Phone
Number
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Enter another student
EMPLOYMENT


Complete the following section for each place of employment for every adult in the household.


Employment #1
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Enter another job
FEDERAL REGULATIONS GOVERNING THE USE OF CHILD CARE FUNDS REQUIRE A RESPONSE TO THE FOLLOWING QUESTIONS:






CHILD CARE NEED

Fill out the following information for each child in child care.


Child #1
Enter another child
CHILD CARE PROVIDER

If your provider is an in-home or informal provider, he/she must be pre-approved by Child Protection Services before we can process your application. Contact your child’s social worker prior to making arrangements for in-home or informal provider care.


If you have more than one child care provider, please fill out the following information for each of them.


Provider #1
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Enter another child care provider


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